Ovarian cancer treatment

How is ovarian cancer treated?

Treatment for ovarian cancer usually involves a combination of surgery and chemotherapy. Less often, treatment may include radiotherapy. The type of treatment women receive depends on the type and stage of their ovarian cancer and their general health.

Treatment is usually managed by a gynaecological oncologist as they specialise in treating cancers of the reproductive tract and have very specialised surgical skills.

Ideally, they will be part of a multidisciplinary health care team - where each member of the team specialises in a different area of care and that care is co-ordinated between each member.

Ovarian cancer treatment and fertility

Treatment for ovarian cancer can affect a woman's ability to have children. If a woman who has not yet gone through menopause has both ovaries removed, she will no longer be able to have children naturally after treatment. If surgery involves removing the uterus, the woman will no longer be able to have children at all.

If ovarian cancer has not spread or if it's found to be a borderline tumour (a type of less aggressive ovarian cancer), it may be possible to just remove only the affected ovary, leaving the other ovary and the uterus. This means that a woman may still fall pregnant after surgery.

Some women need chemotherapy following surgery. When an ovary remains after surgery, having chemotherapy can mean that a woman goes through menopause early. Women who have gone through menopause are no longer able to become pregnant.

Women who were planning to have children before their ovarian cancer diagnosis should speak to their oncologist before starting treatment for ovarian cancer. It may be possible to see a fertility specialist to discuss the available options.

Surgery

The first treatment for ovarian cancer is usually an operation called a 'laparotomy'. This operation is also the main way that a diagnosis of ovarian cancer is confirmed.

During a laparotomy, a long vertical cut is made in your abdomen, which allows the surgeon to find and remove as much of the tumour as possible. In many cases, the surgeon will do a biopsy of the tumour at the beginning of the operation to confirm that it is cancer. This is called a 'frozen section'. If the frozen section confirms that the tumour is cancer, the operation will continue.

For most women, the operation will involve removal of the ovaries, fallopian tubes, the uterus, the omentum (the fat pad around the organs in your abdomen), the appendix and some of the lymph glands in the area. Sometimes it may be necessary to remove some of the bowel.

After your operation, samples of the tissue removed are sent to a laboratory for further examination. The results of these biopsies will provide more information about the type and extent of your cancer and enables the gynaecological oncologist to make decisions about further treatment.

If you were still having menstrual periods before you were diagnosed with ovarian cancer and you have both your ovaries removed, this surgery will result in menopause and can affect a woman's ability to have children. As well as learning that you have ovarian cancer, this surgically-induced menopause and infertility creates all kinds of extra challenges to live with. It's important for women who have not yet completed their family to speak to a doctor before surgery.

Chemotherapy

Most women with ovarian cancer will require chemotherapy, usually referred to as 'chemo'. The purpose of chemo is to attack cancer cells and to slow or stop their growth while causing the least possible damage to normal cells.

Chemotherapy works best when the tumour is small and the cancer cells are actively growing. Even though most of the cancer may have been removed during surgery, there may be some cancer cells left. For this reason, chemotherapy works best if started soon after surgery.

Chemotherapy treatment is given under the guidance of a medical oncologist, who will usually come to see you after your operation to discuss your chemo treatment plan.

Chemotherapy for ovarian cancer is usually given through an intravenous (IV) drip in an outpatient clinic at your treatment hospital. Most women will receive 6 rounds or cycles of treatment with 3 or 4 weeks inbetween each. This means the total treatment time usually continues over several months. Before each treatment, you will have a blood test to make sure your body's normal cells have had time to recover. You will also have blood tests and may have a CT scan to measure your response to the treatment.

If your cancer does not respond completely to the initial treatment, you may need further chemotherapy. You may also need further treatment if your ovarian cancer comes back in the future (this is called 'second line chemo'). The drugs used in further treatments will depend on the chemo drugs initially used, the time between treatments and the aims of the treatment.

Because chemotherapy can also damage some healthy cells in your body it can cause a range of side effects. Side effects are usually temporary and there are many things you can do to prevent or reduce them.

Radiotherapy

Radiotherapy is occasionally used as a treatment option for ovarian cancer. Radiotherapy may be used where cancer is confined to the pelvic cavity. It may also be used in advanced ovarian cancer to reduce the size of the cancer and help to relieve symptoms. Radiotherapy is treatment with special X-rays that are aimed at the specific site of the cancer. The X-ray damages the DNA or genetic code in the cancer cells and this damage kills the cancer cells when they try to grow. Treatment can be external or internal and is given daily over a number of weeks.

Complementary therapies

Many women with ovarian cancer are interested in trying complementary therapies - natural therapies that are used together with mainstream medicine to help manage symptoms and side effects, reduce pain, relieve stress and encourage a feeling of wellbeing.

Sometimes it is helpful to talk to others about your experience.

Ovarian Cancer Australia can provide more information on treatments for ovarian cancer through their website www.ovariancancer.net.au, or by calling their information line on 1300 660 334.

Cancer Council Australia also offers support for you and your loved ones via their helpline on 13 11 20.